In 2024, over 61 million adults in the U.S. experienced a mental illness and deaths due to suicide, gun violence, and drug overdose remained high. Additionally, the COVID-19 pandemic and necessary public health responses exacerbated an already existing mental health and substance use crises. At the same time, many people experience difficulties affording mental health treatment or finding providers. Among insured adults who described their mental health as fair or poor, 43% reported at least one time in the past year when they needed mental health services or medication but did not receive them; some groups – including communities of color, youth and young adults – experience greater barriers.
Many policy actions were initiated in response to these rising mental health and substance use concerns. During the first Trump administration, the SUPPORT Act – legislation that expanded access to opioid treatment and overdose prevention – was passed along with legislation that created the 988 crisis hotline. During the following Biden administration, federal policies focused on expanding coverage, improving access to care, implementing evidence-based treatments, and strengthening support for federal agencies, such as the Substance Abuse and Mental Health Administration (SAMHSA). Recent data shows that some opioid and mental health related indicators have stabilized or improved.
The second Trump administration, beginning in 2025, marked a change in federal mental health and substance use policy. The administration moved toward a heavier law-and-order approach and simultaneously narrowed the scope of federal leadership capacity in mental health and substance use services, while also continuing some treatment-focused initiatives (such as the SUPPORT Act reauthorization). Many of these policy directions are consistent with themes highlighted in President Trump’s campaign materials and are aligned with proposals in Project 2025.
This tracker lists and briefly describes key actions during President Trump’s second term, organized into the following four broad categories: Opioids (for example, signing the HALT Act); Mental Health (e.g., canceling school-based mental health grants); Federal Infrastructure/Data/Guidance (e.g., proposals to reduce and reorganize SAMHSA under another agency); and Gun Violence (e.g., rescinding community violence intervention grants). It will be updated as new changes occur. This tracker is not meant to be exhaustive; other state and federal policy changes may also affect mental health and substance use but are not captured here.
The tracker can be viewed in the order that each mental health or substance use policy action was implemented. Alternatively, the tracker can be filtered by category (Mental Health; Opioids/Substance Use Disorder; Federal Infrastructure/ Data/Guidance; and Gun Violence).
